The gaps in medical innovation

Here are some of the gaps in medical innovation that MSF teams face when trying to give quality care to patients:

Research into medical tools for children is severely neglected

Across the board, paediatric treatments, vaccines and diagnostics are drastically under-researched. The gap between needs and available medicines is powerfully evident in the treatment of HIV/AIDS: because very few children are infected with HIV in rich countries, pharmaceutical companies have no commercial incentive to develop drugs or tests that will work for children. As a result, many antiretrovirals have simply never been tested for children – and when formulations for children do exist, they are often inadequate, as they are unpalatable, contain alcohol, or require refrigeration. Diagnostic tests are also woefully inadequate for children: there is still no simple way to find out whether an infant is infected with HIV/AIDS or TB. And many vaccines too aren’t appropriate for the settings in which MSF works, as they have to be given to children under a certain age (so older children can’t be immunised) or they come in formulations that aren’t suited to remote developing country settings.

Tuberculosis

TB – long considered a poor man’s disease, and now mostly under control in wealthy countries - is one of the biggest killers in the developing world and cases have risen dramatically over the last few years on the back of the HIV/AIDS pandemic. Yet the drugs today were developed almost 50 years ago, and are not up to the task of containing the disease effectively. Around half a million new cases of TB each year are drug-resistant strains. This means that the treatment challenges are even greater: a patient has to take a large number of toxic drugs daily that can be accompanied by very severe side effects, for up to two years.

The tests to detect TB are also completely ill-suited. The most widely used test for TB in most places in developing countries was created in the nineteenth century, only detects certain types of the disease, and even then in only 45-60% of cases. New tests have now arrived on the market and give considerable hope – but they remain sophisticated pieces of machinery that will not be usable in the most remote settings.

TB-HIV/AIDS Co-Infection

Tuberculosis and HIV/AIDS combine to devastating effect. Tuberculosis has now become the biggest killer of people living with HIV/AIDS. Yet because this mostly concerns developing countries, detecting TB in HIV-positive patients is a real difficulty. In addition, some of the antiretrovirals used to treat HIV interact with the anti-tuberculosis drugs, and so doctors can’t treat both diseases at the same time.

Most Neglected Diseases

There are a number of other diseases beyond TB and HIV which receive so little attention from the pharmaceutical industry, that they have been dubbed the ‘most neglected diseases’.

Sleeping sickness: 60 million people are at risk of contracting sleeping sickness or human African trypanosomiasis. Diagnosing this fatal disease requires a lumbar puncture which is far too complex for regular health facilities in affected countries to perform. Often, treatment is woefully inadequate too, as until recently, the most commonly used drug to treat sleeping sickness, based on a highly toxic arsenic derivate, was so toxic that it killed one in 20 patients. Better treatment is now becoming available but it is still lengthy and challenging to administer, requiring skilled staff not always available in the places where patients live.

Kala azar or leishmaniasis kills more than 50,000 people each year, but antimony treatment developed in the 1930s has remained the mainstay of therapy despite considerable toxicity which can result in severe side effects and even death. The treatment is also unsuited because daily injections need to be given for four weeks which means many patients either can’t or won’t complete the course. More than half of those treated experience relapse and the tests to confirm this must be carried out in a well-equipped laboratory by trained staff which means many relapsed patients go undetected.

Chagas disease is found on the American continent and claims up to 15,000 lives a year. Tests to detect the disease exist, but they are too high tech, requiring expensive lab equipment and training. Due to the lack of tests that can be used in remote settings, this chronic disease is usually diagnosed too late for current drugs to be effective. The only two available medicines, nifurtimox and benznidazol, were developed in the 1960 and 70s.

Buruli Ulcer is a skin disease that can result in long-term physical disability such as restriction of joint movement, extensive skin lesions and sometimes life-threatening secondary infections. The current treatment can have severe side effects and has to be delivered through painful injections over a period of many weeks. There are no simple diagnostic tests that can confirm the presence of the disease.